Alzheimer’s disease medication utilization patterns: Disparities in treatment initiation, non‐adherence, and discontinuation

• Published in: Alzheimer's & dementia Vol. 17; no. S10
• Main Authors: Lin, Paige, Daly, Allan, Olchanski, Natalia, Zhu, Yingying, Cohen, Joshua T, Neumann, Peter J, Faul, Jessica D, Fillit, Howard M, Freund, Karen M
• Format: Journal Article
• Language: English
• Published: 01.12.2021
• ISSN: 1552-5260; 1552-5279
• DOI: 10.1002/alz.054849

Background Although currently there is no disease‐modifying treatment for Alzheimer’s disease (AD), several FDA‐approved prescription drugs may ameliorate AD symptoms. This study analyzed AD‐targeted medication utilization patterns in a representative US population overall and by race and ethnicity. Method We analyzed use of cholinesterase inhibitors and memantine for AD, using data from the 2000‐2014 Health and Retirement Study (HRS), linked with Medicare and Medicaid claims. We examined medication initiation among newly‐diagnosed AD patients: 1) the proportion filling an AD prescription ≤90 and ≤365 days after diagnosis; 2) mean/median time from diagnosis to first AD prescription fill; and 3) AD symptom severity at treatment initiation, measured by cognitive and functional limitations. We measured AD medication non‐adherence and discontinuation rates in the year following treatment initiation. We used logistic regression to examine whether AD medication initiation, non‐adherence and discontinuation rates differed by race and ethnicity. We used HRS survey reports to compare the proportion of subjects not filling any prescription due to cost, by race and ethnicity. Result Among individuals with newly‐diagnosed AD (n=1,299), 26% filled an AD prescription ≤90 days and 36% ≤365 days of diagnosis. These proportions and the median time from an incident AD diagnosis to first AD prescription fill did not vary by race/ethnicity. For 3 of 4 measures, AD severity at treatment initiation did not differ across racial/ethnic groups. Of all individuals who initiated AD‐targeted treatment, 44% were non‐adherent and 24% discontinued the medication during the year following treatment initiation. Non‐Hispanic Blacks were more likely than non‐Hispanic whites to not adhere to AD medication therapy (OR: 1.50 [95% CI: 1.07‐2.09] or discontinue treatment (OR: 1.83 [95% CI: 1.27‐2.63]). More non‐Hispanic Blacks and Hispanics with AD reported ever not filling a prescription due to cost, compared to non‐Hispanic whites (42% and 40% vs. 22%, p<0.01). Conclusion Initiation of AD‐targeted medications among newly‐diagnosed patients was suboptimal in all ethnoracial groups, with nearly two‐thirds having no prescription for cholinesterase inhibitors or memantine during the first year post‐diagnosis. Rates of AD medication non‐adherence and discontinuation were substantial and may relate to cost and access to care.